System and method for navigating within the lung

ABSTRACT

Methods and systems for navigating to a target through a patient&#39;s bronchial tree are disclosed including a bronchoscope, a probe insertable into a working channel of the bronchoscope and including a location sensor, and a workstation in operative communication with the probe and the bronchoscope, the workstation including a user interface that guides a user through a navigation plan and is configured to present a central navigation view including a plurality of views configured for assisting the user in navigating the bronchoscope through central airways of the patient&#39;s bronchial tree toward the target, a peripheral navigation view including a plurality of views configured for assisting the user in navigating the probe through peripheral airways of the patient&#39;s bronchial tree to the target, and a target alignment view including a plurality of views configured for assisting the user in aligning a distal tip of the probe with the target.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. patent application Ser. No.15/714,412, filed Sep. 25, 2017, which is a Continuation of U.S. patentapplication Ser. No. 14/753,288 filed Jun. 29, 2015, now U.S. Pat. No.9,770,216, which claims the benefit of the filing date of provisionalU.S. Patent Application Ser. No. 62/020,240 filed on Jul. 2, 2014.

FIELD

The present disclosure relates to devices, systems, and methods fornavigating within the lung.

BACKGROUND

A common device for inspecting the airway of a patient is abronchoscope. Typically, the bronchoscope is inserted into a patient'sairways through the patient's nose or mouth and can extend into thelungs of the patient. A typical bronchoscope includes an elongatedflexible tube having an illumination assembly for illuminating theregion distal to the bronchoscope's tip, an imaging assembly forproviding a video image from the bronchoscope's tip, and a workingchannel through which instruments, e.g., diagnostic instruments such asbiopsy tools, therapeutic instruments can be inserted.

Bronchoscopes, however, are limited in how far they may be advancedthrough the airways due to their size. Where the bronchoscope is toolarge to reach a target location deep in the lungs a clinician mayutilize certain real-time imaging modalities such as fluoroscopy.Fluoroscopic images, while useful present certain drawbacks fornavigation as it is often difficult to distinguish luminal passagewaysfrom solid tissue. Moreover, the images generated by the fluoroscope aretwo-dimensional whereas navigating the airways of a patient requires theability to maneuver in three dimensions.

To address these issues systems have been developed that enable thedevelopment of three-dimensional models of the airways or other luminalnetworks, typically from a series of computed tomography (CT) images.One such system has been developed as part of the ILOGIC®ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® (ENB™) system currently sold byCovidien LP. The details of such a system are described in the commonlyassigned U.S. Pat. No. 7,233,820, filed on Mar. 29, 2004 by Gilboa andentitled ENDOSCOPE STRUCTURES AND TECHNIQUES FOR NAVIGATING TO A TARGETIN BRANCHED STRUCTURE, the contents of which are incorporated herein byreference.

While the system as described in U.S. Pat. No. 7,233,820 is quitecapable, there is always a need for development of improvements andadditions to such systems.

SUMMARY

Provided in accordance with the present disclosure is a system fornavigating to a target through a patient's bronchial tree.

In an aspect of the present disclosure, the system includes abronchoscope configured for insertion into the patient's bronchial tree,a probe insertable into a working channel of the bronchoscope, and aworkstation in operative communication with the probe and thebronchoscope. The probe includes a location sensor and is configured tonavigate through the patient's bronchial tree. The workstation includesa memory and at least one processor. The memory stores a navigation planand a program that, when executed by the processor, presents a userinterface that guides a user through the navigation plan. The userinterface is configured to present a central navigation view including aplurality of views configured for assisting the user in navigating thebronchoscope through central airways of the patient's bronchial treetoward the target, a peripheral navigation view including a plurality ofviews configured for assisting the user in navigating the probe throughperipheral airways of the patient's bronchial tree to the target, and atarget alignment view including a plurality of views configured forassisting the user in aligning a distal tip of the probe with thetarget.

In a further aspect of the present disclosure, each of the centralnavigation view, peripheral navigation view, and target alignment vieware configured to present one or more views selected from the groupconsisting of a bronchoscope view, a virtual bronchoscope view, a localview, a MIP view, a 3D map dynamic view, a 3D map static view, asagittal CT view, an axial CT view, a coronal CT view, a tip view, a 3DCT view, and an alignment view.

In another aspect of the present disclosure, the central navigation viewis configured to present the bronchoscope view, virtual bronchoscopeview, and 3D map dynamic view.

In yet another aspect of the present disclosure, the peripheralnavigation view is configured to present the bronchoscope view, 3D mapdynamic view, tip view, and local view.

In an aspect of the present disclosure, the target alignment view isconfigured to present the 3D map dynamic view, local view, alignmentview, and 3D CT view.

In another aspect of the present disclosure, the 3D map dynamic viewincludes a 3D model of the patient's bronchial tree. The 3D map dynamicview may be configured to automatically adjust the orientation of the 3Dmodel in response to movement of the location sensor within thepatient's airways.

In a further aspect of the present disclosure, the 3D model includes ahighlighted portion indicating a pathway along the patient's bronchialtree to the target.

In another aspect of the present disclosure, at least one of the 3D mapdynamic view or the local view includes a virtual representation of thedistal tip of the probe. The virtual representation may be configured toprovide the user with an indication of an orientation of the distal tipof the probe.

In a further aspect of the present disclosure, the virtualrepresentation of the distal tip of the probe is a 3D virtualrepresentation.

In yet a further aspect of the present disclosure, the distal tip of theprobe defines a configuration selected from the group consisting of alinear, a curved, or an angled configuration. The virtual representationof the distal tip of the probe may have the same configuration as thedistal tip of the probe.

In another aspect of the present disclosure, the 3D map dynamic viewand/or the local view is configured to adjust the orientation of thevirtual representation of the distal tip of the probe in response to achange in orientation of the distal tip of the probe within thepatient's airways.

In a further aspect of the present disclosure, the virtual bronchoscopeview includes a virtual pathway configured to provide the user with anindication of a pathway leading toward the target.

In yet another aspect of the present disclosure, the local view presentsan elevated view of a slice of a 3D volume of the navigation plan. Thelocal view may be configured to change the slice of the 3D volume to bepresented in response to movement of the probe within the patient'sbronchial tree.

In a further aspect of the present disclosure, the local view includes a3D representation of the target disposed relative to the presented sliceof the 3D volume. The presented slice of the 3D volume may define awatermark against the 3D representation of the target indicating arelative position of the 3D representation of the target to thepresented slice of the 3D volume.

In yet another aspect of the present disclosure, a first portion of the3D representation of the target disposed above the presented slice ofthe 3D volume is presented as a first color, and a second portion of the3D representation of the target disposed below the presented slice ofthe 3D volume is presented as a second color.

Any of the above aspects and embodiments of the present disclosure maybe combined without departing from the scope of the present disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

Objects and features of the presently disclosed system and method willbecome apparent to those of ordinary skill in the art when descriptionsof various embodiments thereof are read with reference to theaccompanying drawings, of which:

FIG. 1 is a perspective view of an electromagnetic navigation system inaccordance with the present disclosure;

FIG. 2 is a schematic diagram of a workstation configured for use withthe system of FIG. 1 ;

FIG. 3 is a flow chart illustrating a method of navigation in accordancewith an embodiment of the present disclosure;

FIG. 4 is an illustration of a user interface of the workstation of FIG.2 presenting a view for performing registration in accordance with thepresent disclosure;

FIG. 5 is an illustration of the view of FIG. 4 with each indicatoractivated;

FIG. 6 is an illustration of a user interface of the workstation of FIG.2 , presenting a view for verifying registration in accordance with thepresent disclosure;

FIG. 7 is an illustration of a user interface of the workstation of FIG.2 presenting a view for performing navigation to a target furtherpresenting a central navigation tab;

FIG. 8 is an illustration of the view of FIG. 7 further presenting aperipheral navigation tab;

FIG. 9 is an illustration of the view of FIG. 7 further presenting theperipheral navigation tab of FIG. 8 near the target;

FIG. 10 is an illustration of the view of FIG. 7 further presenting atarget alignment tab;

FIG. 11 is an illustration of the user interface of the workstation ofFIG. 2 presenting a view for marking a location of a biopsy or treatmentof the target; and

FIG. 12 is an illustration of the user interface of the workstation ofFIG. 2 presenting a view for reviewing aspects of registration.

DETAILED DESCRIPTION

Devices, systems, and methods for navigating to a target within aluminal network, for example, a patient's lungs, are provided inaccordance with the present disclosure and described in detail below.The disclosed navigation system and method provides a clinician with aneasy to use workflow guiding the clinician through the various stepsinvolved in performing navigation to a target in the luminal network.For example, the disclosed navigation system and method walk a clinicianthrough a procedure which includes loading a navigation plan, performingregistration, performing central navigation with a bronchoscope,performing peripheral navigation with an extended working channel andlocatable guide, performing target alignment, performing a virtualbiopsy or treatment location marking, and finally performing a biopsy ortreatment of the target. The navigation plan may be based on athree-dimensional model of a patient's lungs. Various methods forgenerating the 3D model are envisioned, some of which are more fullydescribed in co-pending U.S. Pat. Nos. 9,459,770, 9,925,009, and9,639,666, all entitled PATHWAY PLANNING SYSTEM AND METHOD, filed onMar. 15, 2013, by Baker, the entire contents of all of which areincorporated herein by reference. The disclosed navigation system andmethod also provide the clinician with the capability to virtually markand track the locations of multiple biopsies or treatments and to easilyreturn to the marked biopsy or treatment locations.

Additional features of the ENB system of the present disclosure aredescribed in co-pending U.S. Patent Publication No. 2016/0000517,entitled INTELLIGENT DISPLAY, filed on Jun. 29, 2015, by KEHAT et al.;U.S. Pat. No. 9,727,986, entitled UNIFIED COORDINATE SYSTEM FOR MULTIPLECT SCANS OF PATIENT LUNGS, filed on Jul. 1, 2015, by Greenburg; U.S.Pat. No. 10,159,447, entitled ALIGNMENT CT, filed on Jul. 2, 2015, byKlein et al.; U.S. Pat. No. 9,633,431, entitled FLUOROSCOPIC POSEESTIMATION, filed on May 29, 2015, by Merlet; U.S. Pat. No. 9,754,367,entitled TRACHEA MARKING, filed on Jun. 29, 2015, by Lachmanovich etal.; U.S. Pat. No. 9,530,219, entitled SYSTEM AND METHOD FOR DETECTINGTRACHEA, filed on Jun. 30, 2015, by Markov et al.; U.S. Pat. No.9,836,848, entitled SYSTEM AND METHOD FOR SEGMENTATION OF LUNG, filed onJun. 30, 2015, by Markov et al.; U.S. Patent Publication No.2016-0000520, entitled SYSTEM AND METHOD OF PROVIDING DISTANCE ANDORIENTATION FEEDBACK WHILE NAVIGATING IN 3D, filed on Jul. 2, 2015, byLachmanovich et al.; and U.S. Pat. No. 9,603,668, entitled DYNAMIC 3DLUNG MAP VIEW FOR TOOL NAVIGATION INSIDE THE LUNG, filed on Jun. 26,2015, by Weingarten et al., the entire contents of all of which areincorporated herein by reference.

However, these detailed embodiments are merely examples of thedisclosure, which may be embodied in various forms. Therefore, specificstructural and functional details disclosed herein are not to beinterpreted as limiting but merely as a basis for the claims and as arepresentative basis for allowing one skilled in the art to variouslyemploy the present disclosure in virtually any appropriately detailedstructure. While the following embodiments are described in terms ofbronchoscopy of a patient's airways, those skilled in the art willrecognize that the same or similar devices, systems, and methods may beused in other luminal networks, such as, for example, the vascular,lymphatic, and/or gastrointestinal networks as well.

With reference to FIG. 1 , an electromagnetic navigation (EMN) system 10is provided in accordance with the present disclosure. One such ENMsystem is the ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® system currentlysold by Covidien LP. Among other tasks that may be performed using theEMN system 10 are planning a pathway to target tissue, navigating apositioning assembly to the target tissue, navigating a biopsy tool tothe target tissue to obtain a tissue sample from the target tissue usingthe biopsy tool, digitally marking the location where the tissue samplewas obtained, and placing one or more echogenic markers at or around thetarget.

EMN system 10 generally includes an operating table 40 configured tosupport a patient; a bronchoscope 50 configured for insertion throughthe patient's mouth and/or nose into the patient's airways; monitoringequipment 60 coupled to bronchoscope 50 for displaying video imagesreceived from bronchoscope 50; a tracking system 70 including a trackingmodule 72, a plurality of reference sensors 74, and an electromagneticfield generator 76; a workstation 80 including software and/or hardwareused to facilitate pathway planning, identification of target tissue,navigation to target tissue, and digitally marking the biopsy location.

FIG. 1 also depicts two types of catheter guide assemblies 90, 100. Bothcatheter guide assemblies 90, 100 are usable with the EMN system 10 andshare a number of common components. Each catheter guide assembly 90,100 includes a handle 91, which is connected to an extended workingchannel (EWC) 96. The EWC 96 is sized for placement into the workingchannel of a bronchoscope 50. In operation, a locatable guide (LG) 92,including an electromagnetic (EM) sensor 94, is inserted into the EWC 96and locked into position such that the sensor 94 extends a desireddistance beyond the distal tip 93 of the EWC 96. The location of the EMsensor 94, and thus the distal end of the EWC 96, within anelectromagnetic field generated by the electromagnetic field generator76, can be derived by the tracking module 72 and the workstation 80.Catheter guide assemblies 90, 100 have different operating mechanisms,but each contain a handle 91 that can be manipulated by rotation andcompression to steer the distal tip 93 of the LG 92, extended workingchannel 96. Catheter guide assemblies 90 are currently marketed and soldby Covidien LP under the name SUPERDIMENSION® Procedure Kits. Similarly,catheter guide assemblies 100 are currently sold by Covidien LP underthe name EDGE Procedure Kits. Both kits include a handle 91, extendedworking channel 96, and locatable guide 92. For a more detaileddescription of the catheter guide assemblies 90, 100, reference is madeto commonly-owned U.S. Pat. No. 9,247,992 filed Mar. 15, 2013 by Ladtkowet al., the entire contents of which are hereby incorporated byreference.

As illustrated in FIG. 1 , the patient is shown lying on operating table40 with bronchoscope 50 inserted through the patient's mouth and intothe patient's airways. Bronchoscope 50 includes a source of illuminationand a video imaging system (not explicitly shown) and is coupled tomonitoring equipment 60, e.g., a video display, for displaying the videoimages received from the video imaging system of bronchoscope 50.

Catheter guide assemblies 90, 100 including LG 92 and EWC 96 areconfigured for insertion through a working channel of bronchoscope 50into the patient's airways (although the catheter guide assemblies 90,100 may alternatively be used without bronchoscope 50). The LG 92 andEWC 96 are selectively lockable relative to one another via a lockingmechanism 99. A six degrees-of-freedom electromagnetic tracking system70, e.g., those disclosed in U.S. Pat. No. 6,188,355 and published PCTApplication Nos. WO 00/10456 and WO 01/67035, the entire contents ofeach of which is incorporated herein by reference, or any other suitablepositioning measuring system, is utilized for performing navigation,although other configurations are also contemplated. Tracking system 70is configured for use with catheter guide assemblies 90, 100 to trackthe position of the EM sensor 94 as it moves in conjunction with the EWC96 through the airways of the patient, as detailed below.

As shown in FIG. 1 , electromagnetic field generator 76 is positionedbeneath the patient. Electromagnetic field generator 76 and theplurality of reference sensors 74 are interconnected with trackingmodule 72, which derives the location of each reference sensor 74 in sixdegrees of freedom. One or more of reference sensors 74 are attached tothe chest of the patient. The six degrees of freedom coordinates ofreference sensors 74 are sent to workstation 80, which includesapplication 81 where sensors 74 are used to calculate a patientcoordinate frame of reference.

Also shown in FIG. 1 is a catheter biopsy tool 102 that is insertableinto the catheter guide assemblies 90,100 following navigation to atarget and removal of the LG 92. The biopsy tool 102 is used to collectone or more tissue sample from the target tissue. As detailed below,biopsy tool 102 is further configured for use in conjunction withtracking system 70 to facilitate navigation of biopsy tool 102 to thetarget tissue, tracking of a location of biopsy tool 102 as it ismanipulated relative to the target tissue to obtain the tissue sample,and/or marking the location where the tissue sample was obtained.

Although navigation is detailed above with respect to EM sensor 94 beingincluded in the LG 92 it is also envisioned that EM sensor 94 may beembedded or incorporated within biopsy tool 102 where biopsy tool 102may alternatively be utilized for navigation without need of the LG orthe necessary tool exchanges that use of the LG requires. A variety ofuseable biopsy tools are described in U.S. Pat. No. 10,278,680, filedNov. 20, 2013, and U.S. Patent Publication No. 2015/0141809, filed Sep.17, 2014, both entitled DEVICES, SYSTEMS, AND METHODS FOR NAVIGATING ABIOPSY TOOL TO A TARGET LOCATION AND OBTAINING A TISSUE SAMPLE USING THESAME, and U.S. Pat. No. 10,278,680 having the same title and filed Dec.9, 2014, the entire contents of each of which are incorporated herein byreference and useable with the EMN system 10 as described herein.

During procedure planning, workstation 80 utilizes computed tomographic(CT) image data for generating and viewing a three-dimensional model(“3D model”) of the patient's airways, enables the identification oftarget tissue on the 3D model (automatically, semi-automatically ormanually), and allows for the selection of a pathway through thepatient's airways to the target tissue. More specifically, the CT scansare processed and assembled into a 3D volume, which is then utilized togenerate the 3D model of the patient's airways. The 3D model may bepresented on a display monitor 81 associated with workstation 80 or inany other suitable fashion. Using workstation 80, various slices of the3D volume and views of the 3D model may be presented and/or may bemanipulated by a clinician to facilitate identification of a target andselection of a suitable pathway through the patient's airways to accessthe target. The 3D model may also show marks of the locations whereprevious biopsies were performed, including the dates, times, and otheridentifying information regarding the tissue samples obtained. Thesemarks may also be selected as the target to which a pathway can beplanned. Once selected, the pathway is saved for use during thenavigation procedure. An example of a suitable pathway planning systemand method is described in U.S. Pat. Nos. 9,459,770; 9,925,009; and9,639,666, the entire contents of each of which are incorporated hereinby reference.

During navigation, EM sensor 94, in conjunction with tracking system 70,enables tracking of EM sensor 94 and/or biopsy tool 102 as EM sensor 94or biopsy tool 102 is advanced through the patient's airways.

Turning now to FIG. 2 , there is shown a system diagram of workstation80. Workstation 80 may include memory 202, processor 204, display 206,network interface 208, input device 210, and/or output module 212.

Memory 202 includes any non-transitory computer-readable storage mediafor storing data and/or software that is executable by processor 204 andwhich controls the operation of workstation 80. In an embodiment, memory202 may include one or more solid-state storage devices such as flashmemory chips. Alternatively or in addition to the one or moresolid-state storage devices, memory 202 may include one or more massstorage devices connected to the processor 204 through a mass storagecontroller (not shown) and a communications bus (not shown). Althoughthe description of computer-readable media contained herein refers to asolid-state storage, it should be appreciated by those skilled in theart that computer-readable storage media can be any available media thatcan be accessed by the processor 204. That is, computer readable storagemedia includes non-transitory, volatile and non-volatile, removable andnon-removable media implemented in any method or technology for storageof information such as computer-readable instructions, data structures,program modules or other data. For example, computer-readable storagemedia includes RAM, ROM, EPROM, EEPROM, flash memory or other solidstate memory technology, CD-ROM, DVD, Blu-Ray or other optical storage,magnetic cassettes, magnetic tape, magnetic disk storage or othermagnetic storage devices, or any other medium which can be used to storethe desired information and which can be accessed by workstation 80.

Memory 202 may store application 81 and/or CT data 214. Application 81may, when executed by processor 204, cause display 206 to present userinterface 216. Network interface 208 may be configured to connect to anetwork such as a local area network (LAN) consisting of a wired networkand/or a wireless network, a wide area network (WAN), a wireless mobilenetwork, a Bluetooth network, and/or the internet. Input device 210 maybe any device by means of which a user may interact with workstation 80,such as, for example, a mouse, keyboard, foot pedal, touch screen,and/or voice interface. Output module 212 may include any connectivityport or bus, such as, for example, parallel ports, serial ports,universal serial busses (USB), or any other similar connectivity portknown to those skilled in the art.

FIG. 3 depicts an exemplary method of navigation using the navigationworkstation 80 and the user interface 216. In step S300, user interface216 presents the clinician with a view (not shown) for the selection ofa patient. The clinician may enter patient information such as, forexample, the patient name or patient ID number, into a text box toselect a patient on which to perform a navigation procedure.Alternatively, the patient may be selected from a drop down menu orother similar methods of patient selection. Once the patient has beenselected, the user interface 216 presents the clinician with a view (notshown) including a list of available navigation plans for the selectedpatient. In step S302, the clinician may load one of the navigationplans by activating the navigation plan. The navigation plans may beimported from a procedure planning software.

Once the patient has been selected and a corresponding navigation planhas been loaded, the user interface 216 presents the clinician with apatient details view (not shown) in step S304 which allows the clinicianto review the selected patient and plan details. Examples of patientdetails presented to the clinician in the timeout view may include thepatient's name, patient ID number, and birth date. Examples of plandetails include navigation plan details, automatic registration status,and/or manual registration status. For example, the clinician mayactivate the navigation plan details to review the navigation plan, andmay verify the availability of automatic registration and/or manualregistration. The clinician may also activate an edit button (not shown)to edit the loaded navigation plan from the patient details view.Activating the edit button (not shown) of the loaded navigation plan mayalso activate the planning software described above. Once the clinicianis satisfied that the patient and plan details are correct, theclinician proceeds to navigation setup in step S306. Alternatively,medical staff may perform the navigation setup prior to or concurrentlywith the clinician selecting the patient and navigation plan.

During navigation setup in step S306, the clinician or other medicalstaff prepares the patient and operating table by positioning thepatient on the operating table over the electromagnetic field generator76. The clinician or other medical staff position reference sensors 74on the patient's chest and verify that the sensors are properlypositioned, for example, through the use of a setup view (not shown)presented to the clinician or other medical staff by user interface 216.Setup view may, for example, provide the clinician or other medicalstaff with an indication of where the reference sensors 74 are locatedrelative to the magnetic field generated by the transmitter mat 76.Patient sensors allow the navigation system to compensate for patientbreathing cycles during navigation. The clinician also prepares LG 92,EWC 96, and bronchoscope 50 for the procedure by inserting LG 92 intoEWC 96 and inserting both LG 92 and EWC 96 into the working channel ofbronchoscope 50 such that distal tip 93 of LG 92 extends from the distalend of the working channel of bronchoscope 50. For example, theclinician may extend the distal tip 93 of LG 92 10 mm beyond the distalend of the working channel of bronchoscope 50.

Once setup is complete, the user interface 216 presents the clinicianwith a view 400 for registering the location of LG 92 relative to theloaded navigation plan. In step S308 the clinician prepares forregistration by inserting bronchoscope 50 with EWC 96, LG 92 and EMsensor 94 into the patient's airway until the distal ends of the LG 92,the EM sensor 94, and bronchoscope 50 are positioned within thepatient's trachea, for example, as shown in FIG. 4 . The clinician thenactivates registration via input device 210, for example, a mouse orfoot pedal. As shown in FIG. 4 , view 400 presents a clinician with avideo feed 402 from bronchoscope 50 and a lung survey 404. Video feed402 from bronchoscope 50 provides the clinician with a real-time videoof the interior of the patient's airways at the distal end ofbronchoscope 50. Video feed 402 allows the clinician to visuallynavigate through the airways of the lungs.

Lung survey 404 provides the clinician with indicators 406 for thetrachea 408 and each region 410, 412, 414, and 416 of the lungs. Regions410, 412, 414, may also correspond to the patient's lung lobes. It iscontemplated that an additional region (not shown) may be present andmay correspond to the fifth lung lobe, e.g. the middle lung lobe in thepatient's right lung. Lung survey 404 may also be modified for patientsin which all or a part of one of the lungs is missing, for example, dueto prior surgery.

During registration, the clinician advances bronchoscope 50 and LG 92into each region 410, 412, 414, and 416 until the correspondingindicator 406 is activated. For example, the corresponding indicator maydisplay a “check mark” symbol 417 when activated. As described above,the location of the EM sensor 94 at the distal tip 93 of LG 92 relativeto each region 410, 412, 414, and 416 is tracked by the electromagneticinteraction between EM sensor 94 of LG 92 and the electromagnetic fieldgenerator 76 and may activate an indicator 406 when the EM sensor 94enters a corresponding region 410, 412, 414, or 416.

In step S310, once the indicators 406 for the trachea 408 and eachregion 410, 412, 414, and 416 have been activated, for example, as shownin FIG. 5 , the clinician activates the “done” button 418 via inputdevice 210, for example, a mouse or foot pedal, and proceeds toverification of the registration in step S312. Although each indicator406 is shown as activated in FIG. 5 , the clinician may alternativelyachieve registration with the currently loaded navigation plan while oneor more of regions 410, 412, 414, and 416 are not activated. Forexample, so long as the clinician has achieved sufficient registrationwith the currently loaded navigation plan the clinician may activate the“done” button 418 to proceed to registration verification in step S312.More details regarding the process of registration are set forth in U.S.Pat. No. 10,772,532, entitled REAL-TIME AUTOMATIC REGISTRATION FEEDBACK,filed on Jul. 2, 2015, by Brown et al., the entire contents of which isincorporated herein by reference. Sufficient registration may depend onboth the patient's lung structure and the currently loaded navigationplan where, for example, only the indicators 406 for the trachea 408 andone or more of the regions 410, 412, 414, or 416 in one of the lungs maybe necessary to achieve a useable registration where the plan identifiestargets in one lung.

After registration with the currently loaded navigation plan iscomplete, user interface 216 presents the clinician with a view 420 forregistration verification in step S312. View 420 presents the clinicianwith an LG indicator 422 (actually depicting the location of the EMsensor 94) overlaid on a displayed slice 424 of the 3D volume of thecurrently loaded navigation plan, for example, as shown in FIG. 6 .Although the slice 424 displayed in FIG. 6 is from the coronaldirection, the clinician may alternatively select one of the axial orsagittal directions by activating a display bar 426. As the clinicianadvances the LG 92 and bronchoscope 50 through the patient's airways,the displayed slice 424 changes based on the position of the EM sensor94 of LG 92 relative to the registered 3D volume of the navigation plan.The clinician then determines whether the registration is acceptable instep S314. Once the clinician is satisfied that the registration isacceptable, for example, that the LG indicator 422 does not stray fromwithin the patient's airways as presented in the displayed slice 424,the clinician accepts the registration by activating the “acceptregistration” button 428 and proceeds to navigation in step S316.Although registration has now been completed by the clinician, the EMNsystem 10 may continue to track the location of the EM sensor 94 of LG92 within the patient's airways relative to the 3D volume and maycontinue to update and improve the registration during the navigationprocedure.

During navigation, user interface 216 presents the clinician with a view450, as shown, for example, in FIG. 7 . View 450 provides the clinicianwith a user interface for navigating to a target 452 (FIG. 8 ) includinga central navigation tab 454, a peripheral navigation tab 456, and atarget alignment tab 458. Central navigation tab 454 is primarily usedto guide the bronchoscope 50 through the patient's bronchial tree untilthe airways become small enough that the bronchoscope 50 becomes wedgedin place and is unable to advance. Peripheral navigation tab 456 isprimarily used to guide the EWC 96, EM sensor 94, and LG 92 towardtarget 452 (FIG. 8 ) after the bronchoscope 50 is wedged in place.Target alignment tab 458 is primarily used to verify that LG 92 isaligned with the target 452 after LG 92 has been navigated to the target452 using the peripheral navigation tab 456. View 450 also allows theclinician to select target 452 to navigate by activating a targetselection button 460.

Each tab 454, 456, and 458 includes a number of windows 462 that assistthe clinician in navigating to the target. The number and configurationof windows 462 to be presented is configurable by the clinician prior toor during navigation through the activation of an “options” button 464.The view displayed in each window 462 is also configurable by theclinician by activating a display button 466 of each window 462. Forexample, activating the display button 466 presents the clinician with alist of views for selection by the clinician including a bronchoscopeview 470 (FIG. 7 ), virtual bronchoscope view 472 (FIG. 7 ), local view478 (FIG. 8 ), MIP view (not explicitly shown), 3D map dynamic view 482(FIG. 7 ), 3D map static view (not explicitly shown), sagittal CT view(not explicitly shown), axial CT view (not shown), coronal CT view (notexplicitly shown), tip view 488 (FIG. 8 ), 3D CT view 494 (FIG. 10 ),and alignment view 498 (FIG. 10 ).

Bronchoscope view 470 presents the clinician with a real-time imagereceived from the bronchoscope 50, as shown, for example, in FIG. 7 .Bronchoscope view 470 allows the clinician to visually observe thepatient's airways in real-time as bronchoscope 50 is navigated throughthe patient's airways toward target 452.

Virtual bronchoscope view 472 presents the clinician with a 3D rendering474 of the walls of the patient's airways generated from the 3D volumeof the loaded navigation plan, as shown, for example, in FIG. 7 .Virtual bronchoscope view 472 also presents the clinician with anavigation pathway 476 providing an indication of the direction alongwhich the clinician will need to travel to reach the target 452. Thenavigation pathway 476 may be presented in a color or shape thatcontrasts with the 3D rendering 474 so that the clinician may easilydetermine the desired path to travel.

Local view 478, shown in FIG. 8 , presents the clinician with a slice480 of the 3D volume located at and aligned with the distal tip 93 of LG92. Local view 478 shows target 452, navigation pathway 476, andsurrounding airway branches overlaid on slice 480 from an elevatedperspective. The slice 480 that is presented by local view 478 changesbased on the location of EM sensor 94 relative to the 3D volume of theloaded navigation plan. Local view 478 also presents the clinician witha visualization of the distal tip 93 of LG 92 in the form of a virtualprobe 479. Virtual probe 479 provides the clinician with an indicationof the direction that distal tip 93 of LG 92 is facing so that theclinician can control the advancement of the LG 92 in the patient'sairways. For example, as the clinician manipulates the handle 91 of thecatheter guide assembly 90,100, the EWC 96 and the LG 92 locked intoposition relative thereto rotate, and the orientation of the distal end479 a of virtual probe 479 also rotates relative to the displayed slice480 to allow the clinician to guide the LG 92 and EWC 96 through thepatient's airways. The local view 478 also provides the clinician with awatermark 481 that indicates to the clinician the elevation of thetarget 452 relative to the displayed slice. For example, as seen in FIG.8 , the majority of the target 452 is located below watermark 481 andmay, for example, be displayed as having a dark color such as a darkgreen, while a smaller portion of target 452 located above watermark 481may be displayed, for example, as having a light color such as a lightgreen. Any other color scheme which serves to indicate the differencebetween the portion of target 452 disposed above watermark 481 and theportion of target 452 disposed below watermark 481 may alternatively beused.

The MIP view (not explicitly shown), also known in the art as a MaximumIntensity Projection view is a volume rendering of the 3D volume of theloaded navigation plan. The MIP view presents a volume rendering that isbased on the maximum intensity voxels found along parallel rays tracedfrom the viewpoint to the plane of projection. For example, the MIP viewenhances the 3D nature of lung nodules and other features of the lungsfor easier visualization by the clinician.

3D map dynamic view 482 (FIG. 8 ) presents a dynamic 3D model 484 of thepatient's airways generated from the 3D volume of the loaded navigationplan. Dynamic 3D model 484 includes a highlighted portion 486 indicatingthe airways along which the clinician will need to travel to reachtarget 452. The orientation of dynamic 3D model 484 automaticallyupdates based on movement of the EM sensor 94 within the patient'sairways to provide the clinician with a view of the dynamic 3D model 484that is relatively unobstructed by airway branches that are not on thepathway to the target 452. 3D map dynamic view 482 also presents thevirtual probe 479 to the clinician as described above where the virtualprobe 479 rotates and moves through the airways presented in the dynamic3D model 484 as the clinician advances the LG 92 through correspondingpatient airways.

3D map static view (not explicitly shown) is similar to 3D map dynamicview 482 with the exception that the orientation of the static 3D modeldoes not automatically update. Instead, the 3D map static view must beactivated by the clinician to pan or rotate the static 3D model. The 3Dmap static view may also present the virtual probe 479 to the clinicianas described above for 3D map dynamic view 482.

The sagittal, axial, and coronal CT views (not explicitly shown) presentslices taken from the 3D volume of the loaded navigation plan in each ofthe coronal, sagittal, and axial directions. Examples of the coronal,sagittal, and axial CT views can be found in U.S. Pat. No. 9,459,770mentioned above.

Tip view 488 presents the clinician with a simulated view from thedistal tip 93 of LG 92, as shown, for example, in FIG. 8 . Tip view 488includes a crosshair 490 and a distance indicator 492. Crosshair 490 maybe any shape, size, or color that indicates to the clinician thedirection that the distal tip 93 of LG 92 is facing. Distance indicator492 provides the clinician with an indication of the distance from thedistal tip 93 of LG 92 to the center of target 452. Tip view 488 may beused to align the distal tip 93 LG 92 with the target 452.

3D CT view 494 (FIG. 10 ) presents the clinician with a 3D projection496 of the 3D volume located directly in front of the distal tip of LG92. For example, 3D projection 496 presents high density structures suchas, for example, blood vessels, and lesions to the clinician. 3D CT view494 may also present distance indicator 492 to the clinician asdescribed above for tip view 488.

Alignment view 498 (FIG. 10 ) presents the clinician with a 2Dprojection 500 of the 3D volume located directly in front of the distaltip 93 of LG 92, for example, as shown in FIG. 10 . 2D projection 500presents high density structures such as, for example, blood vessels andlesions. In 2D projection 500, target 452 may presented as a color, forexample, green, and may be translucent. Alignment view 498 may alsopresent distance indicator 492 to the clinician as described above fortip view 488.

Navigation to a target 452 will now be described:

Initially, in step S316, view 450 is presented to the clinician by userinterface 202 with central navigation tab 454 active, as shown, forexample, in FIG. 7 . Central navigation tab 454 may be the default tabupon initialization of view 450 by user interface 202. Centralnavigation tab 454 presents the clinician with the bronchoscope view470, virtual bronchoscope view 472, and 3D map dynamic view 482, asdescribed above. Using central navigation tab 452, the cliniciannavigates bronchoscope 50, LG 92, and EWC 96 toward the target 452 byfollowing the navigation pathway 476 of virtual bronchoscope view 472along the patient's airways. The clinician observes the progress ofbronchoscope 50 in each view 470, 472, and 482. In step S318, theclinician determines whether the airways leading to the target havebecome too small for bronchoscope 50 and, if so, wedges the bronchoscope50 in place. Once the bronchoscope 50 has been wedged in place, theclinician activates peripheral navigation tab 456 using input device210, for example, a mouse or foot pedal, and proceeds to peripheralnavigation in step S320.

During peripheral navigation in step S320, peripheral navigation tab 456is presented to the clinician as shown, for example, in FIG. 8 .Peripheral navigation tab 456 presents the clinician with the local view478, 3D Map Dynamic view 482, bronchoscope view 470, and tip view 488.Peripheral navigation tab 456 assists the clinician with navigationbetween the distal end of bronchoscope 50 and target 452. As shown inthe bronchoscope view 470 in FIG. 8 , the clinician extends LG 92 andEWC 96 from the working channel of bronchoscope 50 into the patient'sairway toward target 452. The clinician tracks the progress of LG 92, EMsensor 94, and EWC 96 in the local view 478, the 3D map dynamic view482, and the tip view 488. For example, as described above, and shown inFIG. 8 , the clinician rotates LG 92, EM sensor 94, and EWC 96 relativeto the patient's airways until the tip 479 a of virtual probe 479 isoriented toward the desired airway leading to the target 452. Forexample, the desired airway may be determined based on the navigationpathway 476 presented in local view 478 and the highlighted portion 486presented in 3D map dynamic view 482. The clinician then advances LG 92,EM sensor 94, and the EWC 96 into the desired airway and confirms themovement of the EM sensor 94 relative to the target 452 and thepatient's airways in the 3D map dynamic view 482 and local view 478. Theclinician may also check the location of target 452 on the tip view 488to determine where the target 452 is relative to the orientation of thedistal tip 93 of LG 92 as LG 92 moves closer to the target 452.

When the clinician has advanced the distal tip 93 of LG 92 to target452, as shown, for example, in FIG. 9 , the clinician may decide in stepS322 to activate the target alignment tab 458 to confirm targetalignment with the target 452.

During target alignment in step S324, target alignment tab 458 ispresented to the clinician as shown, for example, in FIG. 10 . Targetalignment tab 458 presents the clinician with the local view 478, 3D MapDynamic view 482, 3D CT view 494, and Alignment view 498. Targetalignment tab 458 assists the clinician with alignment of the LG 92 withthe target 452. By comparing the 3D and 2D projections of the 3D CT view494 and alignment view 498 with the position and orientation of thevirtual probe 479 in the local view 488 and 3D map dynamic view 482, theclinician may make a determination of whether the distal tip 93 of LG 92is aligned with the target 452 and of the relative distance of thedistal tip 93 of LG 92 to the target 452.

After the clinician determines that the target has been aligned in stepS326 using the target alignment tab 458, or if the clinician decides notto activate the target alignment view 458 in step S322, the clinicianmay decide to activate the “mark position” button 502 of either theperipheral navigation tab 456 (FIG. 9 ) or the target alignment tab 458(FIG. 10 ) in step S328 to virtually mark the current position of thevirtual probe 479 where the registered position of the virtual probe 479corresponds to the current location of the distal tip 93 of LG 92. Thismark may be permanently recorded as part of the navigation plan toenable a clinician to return to substantially the same location insubsequent navigations or at a later time in the same procedure, forexample, where a biopsy sample has been taken and is determined to becancerous and in need of immediate treatment. More details regarding theprocess of virtually marking a biopsy location are set forth in U.S.Patent Publication No. 2016/0000414, entitled METHODS FOR MARKING BIOPSYLOCATION, filed on Jun. 29, 2015, by Brown, the entire contents of whichis incorporated herein by reference.

Once the clinician has activated the “mark position” button 502, theuser interface 216 presents the clinician with a view 504 providing theclinician with details of the marked position of the virtual probe 470,as shown, for example, in FIG. 11 . For example, view 504 provides theclinician with a biopsy or treatment position number 506 and distance totarget center 508 for the clinicians review. While view 504 ispresented, the clinician may withdraw the LG 92 from EWC 96 of thebronchoscope 50 and insert a tool through EWC 96 in step S330, forexample, a biopsy device 102, a fiducial marking device, an ablationprobe, a chemical treatment probe, or other similar tools to sample,mark and/or treat the target 452. Once the clinician has finishedsampling, marking, and/or treating the target 452 using the tool, theclinician withdraws the tool from bronchoscope 50 and inserts LG 92 backinto bronchoscope 50. The clinician then activates the “done” button 510to finish marking the target 452.

Once the “done” button 506 has been activated, the user interface 216presents the clinician with view 500 with one of tabs 454, 456, or 458active. As can be seen in FIG. 10 , for example, a representation of avirtual marker 512 is presented by target alignment tab 458 in variousviews including, for example, the 3D Map Dynamic view 482, local view488, or any other view described above to indicate to the clinician thelocation of a previous treatment site. The clinician then determineswhether an additional biopsy, marking, or treatment is required for thetarget 452 in step S332. If additional biopsies are required, theclinician repeats steps S320 through S330. Because the clinician hasalready navigated to the target 452, the clinician may alternativelyrepeat only a subset of steps S320 through S330. For example, theclinician may return to the target alignment tab 458 without activatingthe peripheral navigation tab 456 to continue navigating to the targetor aligning the LG 92 with the target for an additional biopsy, marking,or treatment. Alternatively, the clinician may use only the peripheralnavigation tab 456 to continue navigating to the target 452 for anadditional biopsy or treatment.

If no additional biopsies or treatments are required, the cliniciandetermines whether there is an additional target planned for navigationby activating the target selection button 460 in step S334. If anadditional target is planned for navigation, the clinician activates theadditional target and repeats steps S316 through S332 to navigate to theadditional target for biopsy or treatment. If the additional target isin the same lung lobe or region as target 452, the clinician mayalternatively only repeat a subset of steps S316 through S332. Forexample, the clinician may start navigation to the additional targetusing the peripheral navigation tab 456 (step S320) or the targetalignment tab 458 (step S324) without using the central navigation tab454 (step S316) where the location of the wedged bronchoscope 50 canstill provide access to the additional target.

If there are no other targets, the clinician has finished the navigationprocedure and may withdraw the LG 92, EWC 96, and bronchoscope 50 fromthe patient. The clinician may then export a record of the navigationprocedure in step S336 to memory 202, to a USB device via output module212, or to a server or other destination for later review via networkinterface 208.

During the navigation procedure, the EM sensor 94 of LG 92 maycontinuously update workstation 80 with registration information suchthat the registration is continuously updated. In addition, workstation80 may automatically adjust the registration when the registeredlocation of EM sensor 94 of LG 92 in the 3D volume is found to belocated outside of an airway of the 3D volume such that EM sensor 94 ofLG 92 is reregistered to be within an airway of the 3D volume. Forexample, the registration may be updated such that the location of theEM sensor 94 in the 3D volume is automatically snapped to the nearestairway. In this manner a dynamic registration of the location of EMsensor 94 of LG 92 relative to the 3D volume of the loaded navigationplan may be accomplished.

At any time during the navigation procedure the clinician may alsoreview the registration by activating the “options” button 464 andactivating a review registration button (not shown). The user interface216 then presents the clinician with a view 514 as shown, for example,in FIG. 12 . View 514 presents the clinician with a 3D model 516 of thepatient's bronchial tree generated from the 3D volume of the loadednavigation plan for review of the registration. As shown in FIG. 12 , 3Dmodel 516 includes a set of data points 518 that are generated duringregistration based on the locations to which the sensor 94 of LG 92 hastraveled within the patient's airways. The data points 518 are presentedon the 3D model 516 to allow the clinician to assess the overallregistration of the 3D model 516 with the patient's airways. Inaddition, during navigation to target 452, a second set of data points520 are generated based on the locations to which the sensor 94 of LG 92has traveled on its path to the target 452. Data points 518 and 520 maybe color coded, for example, green and purple, respectively, or may havedifferent shapes or other identifying features that allow the clinicianto differentiate between data points 518 and 520. The clinician may alsoactivate or de-activate check boxes 522 to control which sets of datapoints 518 and 520 are presented in the 3D model 516.

As used herein, the term “distal” refers to the portion that is beingdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, to the extent consistent, any of the aspects and featuresdetailed herein may be used in conjunction with any or all of the otheraspects and features detailed herein.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. A method for navigating to a target through apatient's bronchial tree, the method comprising: receiving positioninformation from a location sensor coupled to a probe insertable into aworking channel of a bronchoscope and configured to be navigated throughthe patient's bronchial tree; generating a peripheral navigation viewincluding a plurality of views for navigating the probe throughperipheral airways of the patient's bronchial tree to the target basedat least in part on the position information received from the locationsensor; generating a target alignment view including a plurality ofviews for aligning a distal tip of the probe with the target based atleast in part on the position information received from the locationsensor; and displaying the peripheral navigation view or the targetalignment view, wherein at least one of the peripheral navigation viewand the target alignment view includes a local view including: a displayof a 2D slice from a plurality of 2D slices of a 3D volume, the 2D slicedisplayed horizontally within a 3D window and selected from theplurality of 2D slices based on a current orientation of a longitudinalaxis of the probe and the position information received from thelocation sensor, a position of the 2D slice within the 3D windowchanging based on a change in the position information received from thelocation sensor; a virtual representation of the probe overlaid onto the2D slice in the 3D window, the virtual representation of the probe beingfixed relative to the 3D window as the display of the 2D slice changes;and a 3D representation of the target displayed relative to the 2D slicein the 3D window, the 3D representation of the target including an upperportion of the target located above the 2D slice within the 3D windowand a lower portion of the target located below the 2D slice within the3D window.
 2. The method according to claim 1, further comprisingdisplaying a central navigation view for navigating a bronchoscopethrough central airways of the patient's bronchial tree toward thetarget.
 3. The method according to claim 1, wherein each of theperipheral navigation view and the target alignment view are configuredto present one or more views selected from the group consisting of abronchoscope view, a virtual bronchoscope view, a local view, a MIPview, a 3D map dynamic view, a 3D map static view, a sagittal CT view,an axial CT view, a coronal CT view, a tip view, a 3D CT view, and analignment view.
 4. The method according to claim 3, wherein theperipheral navigation view is configured to present the bronchoscopeview, 3D map dynamic view, tip view, and local view.
 5. The methodaccording to claim 3, wherein the target alignment view is configured topresent the 3D map dynamic view, local view, alignment view, and 3D CTview.
 6. The method according to claim 3, wherein the 3D map dynamicview includes a 3D model of the patient's bronchial tree, the 3D mapdynamic view configured to automatically adjust the orientation of the3D model in response to movement of the location sensor within thepatient's bronchial tree.
 7. The method according to claim 6, whereinthe 3D model includes a highlighted portion indicating a pathway throughthe patient's bronchial tree to the target.
 8. The method according toclaim 3, wherein at least one of the 3D map dynamic view and the localview includes a virtual representation of the distal tip of the probe,the virtual representation configured to provide an indication of anorientation of the distal tip of the probe.
 9. The method according toclaim 8, wherein the distal tip of the probe defines a configurationselected from the group consisting of a linear, a curved, or an angledconfiguration, and wherein the virtual representation of the distal tipof the probe has the same configuration as the distal tip of the probe.10. The method according to claim 8, wherein at least one of the 3D mapdynamic view and the local view is configured to adjust the orientationof the virtual representation of the distal tip of the probe in responseto a change in orientation of the distal tip of the probe within thepatient's airways.
 11. The method according to claim 3, wherein thevirtual bronchoscope view includes a virtual pathway configured toprovide an indication of a pathway leading toward the target.
 12. Themethod according to claim 1, wherein the local view includes a watermarkdisplayed against the 3D representation of the target in the 3D window.13. The method according to claim 1, wherein at least one of theperipheral navigation view and the target alignment view includes anindication of a distance between the probe and the target.
 14. A methodfor navigating a probe to a target through a patient's bronchial tree,the method comprising: displaying a peripheral navigation view fornavigating the probe through peripheral airways of the patient'sbronchial tree to the target based at least in part on positioninformation of the probe; and displaying a target alignment view foraligning a distal tip of the probe with the target based at least inpart on the position information of the probe, wherein at least one ofthe peripheral navigation view and the target alignment view includes alocal view including: a display of a 2D slice from a plurality of 2Dslices of a 3D volume, the 2D slice displayed horizontally within a 3Dwindow and selected from the plurality of 2D slices based on a currentorientation of a longitudinal axis of the probe and the positioninformation of the probe a position of the 2D slice within the 3D windowchanging based on a change in the position information the probe; avirtual representation of the probe overlaid onto the 2D slice in the 3Dwindow, the virtual representation of the probe being fixed relative tothe 3D window as the display of the 2D slice changes; and a 3Drepresentation of the target displayed relative to the 2D slice in the3D window, the 3D representation of the target including an upperportion located above the 2D slice within the 3D window and a lowerportion located below the 2D slice within the 3D window.
 15. The methodaccording to claim 14, further comprising displaying a 3D map dynamicview including a 3D model of the patient's bronchial tree.
 16. Themethod according to claim 15, further comprising automatically adjustingan orientation of the 3D model in response to a change in the positioninformation of the probe.
 17. The method according to claim 14, whereinthe local view includes a watermark displayed against the 3Drepresentation of the target in the 3D window.
 18. The method accordingto claim 14, wherein at least one of the peripheral navigation view andthe target alignment view includes an indication of a distance betweenthe probe and the target.
 19. A method for navigating a probe to atarget through a patient's bronchial tree, the method comprising:displaying a target alignment view for aligning a distal tip of theprobe with the target based at least in part on position information ofthe probe, wherein the target alignment view includes a local viewincluding: a display of a 2D slice from a plurality of 2D slices of a 3Dvolume, the 2D slice displayed horizontally within a 3D window andselected from the plurality of 2D slices based on a current orientationof a longitudinal axis of the probe and the position information of theprobe, a position of the 2D slice within the 3D window changing based ona change in the position information the probe; a virtual representationof the probe overlaid onto the 2D slice in the 3D window, the virtualrepresentation of the probe being fixed relative to the 3D window as thedisplay of the 2D slice changes; a 3D representation of the targetdisplayed relative to the 2D slice in the 3D window, the 3Drepresentation of the target including an upper portion located abovethe 2D slice within the 3D window and a lower portion located below the2D slice within the 3D window; and a watermark displayed against the 3Drepresentation of the target in the 3D window.
 20. The method accordingto claim 19, further comprising: displaying a 3D map dynamic viewincluding a 3D model of the patient's bronchial tree; and automaticallyadjusting an orientation of the 3D model in response to a change in theposition information of the probe.